Cardiac magnetic resonance imaging in early diagnostics of myocardial inflammation after COVID-19: Case series and literature review

M. Zdravković, S. Klašnja, M. Popovic, Predrag Đuran, A. Manojlovic, Milica Brajkovic, O. Markovic, I. Jovanovic, M. Branković, V. Popadić
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Abstract

Although, in the beginning, it was considered a respiratory infection with bilateral pneumonia as its main manifestation, COVID-19 is more of a multisystemic disease with various extrapulmonary manifestations. Cardiovascular manifestations are caused by direct viral involvement or by the effects of different cytokines on the myocardium and can occur during the acute phase of the disease or in the post-acute stadium. The most common cardiovascular symptoms in the post-acute COVID-19 stadium are fatigue, shortness of breath, chest pain, and palpitations. Routine cardiovascular diagnostics in these patients is usually without significant findings, although underlying myocardial inflammation may be present. Myocardial damage can also be the substrate for the worsening of heart failure and different potentially life-threatening arrhythmias, which is extremely important for further treatment and prognosis. Cardiac magnetic resonance imaging is a sophisticated, non-radiating imaging modality that can provide important information regarding left and right ventricle volumes and function, tissue characterization, and scar quantification. It is the golden standard in non-invasive diagnostics of myocarditis. In patients with prior COVID-19 infection and cardiovascular symptoms, typical signs of myocarditis, including myocardial edema, necrosis, and myocardial scarring, may be seen in cardiac magnetic resonance. Also, there are sophisticated cardiac magnetic resonance imaging modalities that can register subtle changes in the myocardium, in terms of myocardial inflammation, without visible signs in standard sequences. We present a case series of patients with different myocardial inflammation patterns, followed by a comprehensive review of potential pathophysiological mechanisms, complications, treatment and prognosis of patients with myocarditis or pericarditis after COVID-19.
心脏磁共振成像在COVID-19后心肌炎症早期诊断中的应用:病例系列和文献复习
虽然最初被认为是以双侧肺炎为主要表现的呼吸道感染,但COVID-19更多的是一种多系统疾病,具有多种肺外表现。心血管表现是由病毒直接参与或不同细胞因子对心肌的作用引起的,可发生在疾病的急性期或急性期后。COVID-19急性后体育场最常见的心血管症状是疲劳、呼吸短促、胸痛和心悸。这些患者的常规心血管诊断通常没有明显的发现,尽管可能存在潜在的心肌炎症。心肌损伤也可能是心衰和各种可能危及生命的心律失常恶化的基础,这对进一步治疗和预后至关重要。心脏磁共振成像是一种复杂的非辐射成像方式,可以提供关于左右心室体积和功能、组织特征和疤痕量化的重要信息。它是无创性心肌炎诊断的黄金标准。在既往感染COVID-19并有心血管症状的患者中,心脏磁共振可观察到典型的心肌炎征象,包括心肌水肿、坏死和心肌瘢痕。此外,有复杂的心脏磁共振成像模式可以记录心肌的细微变化,就心肌炎症而言,在标准序列中没有可见的迹象。我们报告了一系列不同心肌炎症模式的患者病例,并对COVID-19后心肌炎或心包炎患者的潜在病理生理机制、并发症、治疗和预后进行了全面综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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